CAJ | 학술논문

目的：比较逆转录酶区A181T/V变异与A181T/V+N236T变异的乙型肝炎病毒感染者临床特征的异同。方法对55例发生rtA181T/V单独变异和34例发生rtA181T/V+rtN236T联合变异的乙型肝炎病毒感染者既往核苷（酸）类似物治疗情况进行回顾，对耐药时谷丙转氨酶、谷草转氨酶、HBV M、HBV DNA等指标进行检测，并根据耐药测序结果确定病毒的基因型。结果阿德福韦单药治疗患者发生A181T/V+N236T变异较A181T/V变异的比例高（57.6%对42.4%，P<0.05），而拉米夫定换用（或加用）阿德福韦治疗患者发生 A181T/V 变异较A181T/V+N236T变异的比例高（75.5%对24.5%，P<0.05）；在89例患者中B基因型和C基因型分别是14例和75例，不同变异在B或C基因型中的分布无统计学差异；A181T/V变异与A181T/V+N236T变异相比，两组患者的年龄、性别构成、谷丙转氨酶、谷草转氨酶、HBV DNA、HBsAg定量、HBeAg状态等指标均无统计学差异。结论不同的核苷（酸）类似物治疗可导致A181T/V变异和A181T/V+N236T变异模式的差异，但这两种变异感染者临床指标无明显差异。
목적：비교역전록매구A181T/V변이여A181T/V+N236T변이적을형간염병독감염자림상특정적이동。방법대55례발생rtA181T/V단독변이화34례발생rtA181T/V+rtN236T연합변이적을형간염병독감염자기왕핵감（산）유사물치료정황진행회고，대내약시곡병전안매、곡초전안매、HBV M、HBV DNA등지표진행검측，병근거내약측서결과학정병독적기인형。결과아덕복위단약치료환자발생A181T/V+N236T변이교A181T/V변이적비례고（57.6%대42.4%，P<0.05），이랍미부정환용（혹가용）아덕복위치료환자발생 A181T/V 변이교A181T/V+N236T변이적비례고（75.5%대24.5%，P<0.05）；재89례환자중B기인형화C기인형분별시14례화75례，불동변이재B혹C기인형중적분포무통계학차이；A181T/V변이여A181T/V+N236T변이상비，량조환자적년령、성별구성、곡병전안매、곡초전안매、HBV DNA、HBsAg정량、HBeAg상태등지표균무통계학차이。결론불동적핵감（산）유사물치료가도치A181T/V변이화A181T/V+N236T변이모식적차이，단저량충변이감염자림상지표무명현차이。
Objective To compare the clinical features between patients infected with hepatitis B virus (HBV)presenting A181T/V mutation or A181T/V+N236T mutation in HBV reverse transcriptase region after nucle-oside treatment. Methods Fifty-five patients with rtA181T/V mutation and 34 patients with rtA181T/V+rtN236T mutation were enrolled in this study. Their administration of nucleoside analogues was reviewed;Serum ALT, AST,HBV M and HBV DNA were detected;HBV genotypes were determined by DNA sequencing. Results In adefovir treatment group,the A181T/V+N236T mutation was more common than rtA181T/V mutation(57.6% vs. 42.4%, P<0.05),while the occurrence of rtA181T/V mutation was higher than A181T/V+N236T mutation in patients re-ceiving lamivudine treatment(75.5% vs. 24.5%,P<0.05);In the total 89 patients in our series,there were 14 cases with genotypes B and 75 cases with genotype C of HBV infection,and there was no significant difference in the distribution of mutations between patients with either of the two genotype infection; There were no statistical dif-ferences as respect to age,gender,ALT,AST,HBV DNA, HBsAg titers and HBeAg status between the two groups of patients with different mutations. Conclusions A given nucleoside analogue treatment leads to specific pattern of HBV reverse transcriptase region mutation;However,there is no special clinical significance between different mutations.